Factors influencing male involvement in maternal and child health care from the health center of Xai-Xai city, Mozambique: a cross-sectional qualitative study.

Introduction: Male participation in maternal and child healthcare (MCH) is essential for improving health outcomes for women and children. Despite evidence that male involvement enhances adherence to medical recommendations and reduces maternal and infant mortality, pregnancy and childbirth are traditionally viewed as women's responsibilities in many settings in Mozambique. This study aimed to explore women's perceptions of the factors influencing the low participation of male partners in MCH at the Xai-Xai City Health Center, Mozambique. Material and methods: A qualitative cross-sectional study was conducted between June and August 2022. Purposive sampling was used to recruit 15 women aged 18-35 years attending antenatal care or well-child consultations without their partners. Data were collected through semi-structured interviews and analyzed using inductive content analysis with MAXQDA software. Two researchers independently coded the transcripts and resolved discrepancies through discussion until consensus was reached. Data saturation was considered achieved when no new themes emerged from successive interviews. Results: The study included 15 women, most aged 18-24 years (60%) and residing in urban areas (60%). Participants identified multiple barriers to male participation in maternal and child healthcare. Sociocultural norms positioned pregnancy and childcare as women's responsibilities, contributing to male absence. Economic constraints, including work obligations and transport costs, further limited participation. Fear of HIV testing, associated with stigma and potential relationship conflict, emerged as an additional deterrent. Health system barriers, such as long waiting times, limited privacy, and clinic hours incompatible with men's work schedules, were also reported. Despite these challenges, women generally expressed satisfaction with the quality of care, although concerns about confidentiality persisted. Conclusions: Male participation in maternal and child healthcare in Xai-Xai City remains constrained by interconnected sociocultural, economic, HIV-related, and health system barriers. Addressing these challenges requires gender-transformative and health system responsive strategies, including male-friendly services, improved confidentiality, and community-based interventions to promote shared responsibility for maternal and child health. These findings provide a localized evidence base for the Ministry of Health to strengthen family-centered care in high-HIV-prevalence to improve health policies in Gaza Province.